- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $12.59 / $19.50
| Facility | 26 | $12.02 | $12.59 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $85.11 / $102.33
| Facility | TC | $25.12 | $85.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $41.69 / $81.28
| Professional | | $33.11 | $41.69 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $30.90
| Professional | 26 | $12.02 | $14.13 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $46.77
| Professional | TC | $20.89 | $26.92 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Professional | TC | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $134.90
| Facility | TC | $100.00 | $100.00 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $56.23 / $100.00
| Professional | | $43.65 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $14.79 / $23.99 / $38.02
| Professional | 26 | $14.79 | $23.99 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $66.07
| Professional | TC | $28.18 | $31.62 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $52.48 / $81.28
| Professional | | $40.74 | $52.48 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.85 / $20.42 / $35.48
| Professional | 26 | $15.85 | $20.42 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $52.48
| Professional | TC | $24.55 | $33.11 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $51.29 / $85.11
| Professional | | $38.02 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.14 / $19.05 / $31.62
| Professional | 26 | $15.14 | $19.05 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.39 / $31.62 / $54.95
| Professional | TC | $22.39 | $31.62 | $54.95 |